EXAMPLE: J-1 Exchange Visitor Researcher, Professor or Short-Term Scholar Category and J-2 Dependents

8843
OMB No. 1545-0074
Statement for Exempt Individuals and Individuals
Form
With a Medical Condition
For use by alien individuals only. 2009
Department of the Treasury For the year January 1—December 31, 2009, or other tax year Attachment
Internal Revenue Service beginning , 2009, and ending , 20 . Sequence No. 102
Your first name and initial Last name Your U.S. taxpayer identification number, if any
Given Name SSN or ITIN. If you are filing only this form and do
Family Name not have an SSN or ITIN, leave blank
Address in country of residence Address in the United States
Fill in your
addresses only if Your permanent residence address in
you are filing this Your local address in the U.S.
your home country
form by itself and
not with your tax
return
Part I General Information
䊳
1a-Put J-1 and first date of entry into the U.S. as J visa holder
1a Type of U.S. visa (for example, F, J, M, Q, etc.) and date you entered the United States
b Current nonimmigrant status and date of change (see instructions) 䊳 Complete only if your status changed during 2009

Enter your country of citizenship

2 Of what country were you a citizen during the tax year?
3a What country issued you a passport? Enter the name of the country that issued your passport
b Enter your passport number 䊳 Enter your passport number
4a Enter the actual number
4a-For each of days years,
of these you were
enterpresent in the
the number United
of days you States during: present in the U.S. Do not count any days you were outside
were physically
2009 the U.S.2008 2007
for any reason (trip home, vacation, research in a foreign country, etc.)
b Enter the number of the
4b-Enter days in number
total 2009 you claim
of days youyou can
were exclude
in the U.S. infor purposes
2009. Answer of the agree
should substantial
with thepresence
# of days test 䊳 in 4a for the year 2009
you put
Part II Teachers and Trainees
5 For teachers, enter the name, address, and telephone number of the academic institution where you taught in 2009 䊳

Columbia University in the City of New York, 2960 Broadway, New York, NY 10027-6902 (212) 854-1754

6 For trainees, enter the name, address, and telephone number of the director of the academic or other specialized program
you participated in during 2009 䊳 Sarah Taylor, Associate Director, International Students and Scholars Office

Columbia University, 2960 Broadway, Mail Code 5724, New York, NY 10027, (212) 854-3587
7. If you were present in the U.S. in J or Q status,
7 Enter the type of U.S. visa (J or Q) you held during: 䊳 2003 indicate 2004
which of the listed years by putting J or Q
2005 2006 2007 2008 . If the type of visa you held during any
of these years changed, attach a statement showing the new visa type and the date it was acquired.
8 Were you present in the United States as a teacher, trainee, or student for any part of 2 of the 6 prior
calendar years (2003 through 2008)? Check Yes or No Yes No
If you checked the “Yes” box on line 8, you cannot exclude days of presence as a teacher or trainee
unless you meet the Exception explained on page 3.
Part III Students SKIP PART III
9 Enter the name, address, and telephone number of the academic institution you attended during 2009 䊳

10 Enter the name, address, and telephone number of the director of the academic or other specialized program you participated
in during 2009 䊳

11 Enter the type of U.S. visa (F, J, M, or Q) you held during: 䊳 2003 2004
2005 2006 2007 2008 . If the type of visa you held during any
of these years changed, attach a statement showing the new visa type and the date it was acquired.
12 Were you present in the United States as a teacher, trainee, or student for any part of more than 5 calendar
years? Yes No
If you checked the “Yes” box on line 12, you must provide sufficient facts on an attached statement to
establish that you do not intend to reside permanently in the United States.
13 During 2009, did you apply for, or take other affirmative steps to apply for, lawful permanent resident
status in the United States or have an application pending to change your status to that of a lawful
permanent resident of the United States? Yes No
14 If you checked the “Yes” box on line 13, explain 䊳

For Paperwork Reduction Act Notice, see page 4. Cat. No. 17227H Form 8843 (2009)
Form 8843 (2009) Page 2
Part IV Professional Athletes SKIP PART IV
15 Enter the name of the charitable sports event(s) in the United States in which you competed during 2009 and the dates of
competition 䊳

16 Enter the name(s) and employer identification number(s) of the charitable organization(s) that benefited from the sports
event(s) 䊳

Note. You must attach a statement to verify that all of the net proceeds of the sports event(s) were contributed to the charitable
organization(s) listed on line 16.
Part V Individuals With a Medical Condition or Medical Problem SKIP PART V
17a Describe the medical condition or medical problem that prevented you from leaving the United States 䊳

b Enter the date you intended to leave the United States prior to the onset of the medical condition or medical problem described
on line 17a 䊳

c Enter the date you actually left the United States 䊳

18 Physician’s Statement:

I certify that
Name of taxpayer

was unable to leave the United States on the date shown on line 17b because of the medical condition or medical problem
described on line 17a and there was no indication that his or her condition or problem was preexisting.

Name of physician or other medical official

Physician’s or other medical official’s address and telephone number

Physician’s or other medical official’s signature Date

Sign here Under penalties of perjury, I declare that I have examined this form and the accompanying attachments, and to the best of my knowledge and
only if you belief, they are true, correct, and complete.
are filing
this form by
itself and
not with
䊳 䊳
Sign your name Date form signed
your tax
return Your signature Date

Form 8843 (2009)

Form 8843 (2009) Page 3

General Instructions 5. Days you were an exempt 3. You were present in the United
individual. States as a teacher or trainee in any of
Section references are to the Internal the 6 prior years.
Revenue Code unless otherwise Exempt Individuals
specified. For purposes of the substantial presence 4. A foreign employer paid all of your
test, an exempt individual includes compensation during each of those prior
Note. You can download forms and 6 years you were present in the United
publications from the IRS website at anyone in the following categories.
States as a teacher or trainee.
www.irs.gov. ● A teacher or trainee (defined on this
page). For more details, see Pub. 519, U.S.
Who Must File Tax Guide for Aliens.
● A student (defined on this page).
If you are an alien individual, you must file If you meet this exception, you must
Form 8843 to explain the basis of your ● A professional athlete temporarily attach information to verify that a foreign
claim that you can exclude days of present in the United States to compete employer paid all the compensation you
presence in the United States for in a charitable sports event. received in 2009 and all prior years that
purposes of the substantial presence test ● An individual temporarily present in you were present in the United States as
because you: the United States as a foreign a teacher or trainee.
● Were an exempt individual (other than a government-related individual.
foreign government-related individual) or
Part III—Students
Alien individuals with “Q” visas are
A student is an individual who is
● Were unable to leave the United States treated as students, teachers, or trainees
temporarily present in the United States
because of a medical condition or and, as such, are exempt individuals for
purposes of the substantial presence test under an “F,” “J,” “M,” or “Q” visa and
medical problem. who substantially complies with the
if they otherwise qualify. “Q” visas are
Substantial Presence Test issued to aliens participating in certain requirements of the visa.
You are considered a U.S. resident if you international cultural exchange programs. If you were a student under an “F,”
meet the substantial presence test for “J,” “M,” or “Q” visa, you are considered
2009. You meet this test if you were Part II—Teachers and to have substantially complied with the
physically present in the United States for Trainees visa requirements if you have not
at least: A teacher or trainee is an individual who engaged in activities that are prohibited
● 31 days during 2009 and is temporarily present in the United States by U.S. immigration laws and could
under a “J” or “Q” visa (other than as a result in the loss of your visa status.
● 183 days during the period 2009, 2008,
and 2007, counting all the days of student) and who substantially complies Even if you meet these requirements,
physical presence in 2009 but only 1/3 with the requirements of the visa. you cannot exclude days of presence in
the number of days of presence in 2008 If you were a teacher or trainee under a 2009 as a student if you were exempt as
and only 1/6 the number of days in 2007. “J” or “Q” visa, you are considered to a teacher, trainee, or student for any
have substantially complied with the visa part of more than 5 calendar years
Note. To claim the closer connection to a unless you establish that you do not
foreign country(ies) exception to the requirements if you have not engaged in
activities that are prohibited by U.S. intend to reside permanently in the
substantial presence test described in United States. The facts and
Regulations section 301.7701(b)-2, you immigration laws that could result in the
loss of your “J” or “Q” visa status. circumstances to be considered in
must file Form 8840, Closer Connection determining if you have demonstrated an
Exception Statement for Aliens. Even if you meet these requirements, intent to reside permanently in the
Days of presence in the United States. you cannot exclude days of presence in United States include, but are not limited
Generally, you are treated as being 2009 as a teacher or trainee if you were to:
present in the United States on any day exempt as a teacher, trainee, or student
for any part of 2 of the 6 prior calendar 1. Whether you have maintained a
that you are physically present in the closer connection to a foreign country
country at any time during the day. years. But see the Exception below.
than to the United States (for details,
However, you do not count the following If you qualify to exclude days of see Pub. 519) and
days of presence in the United States for presence as a teacher or trainee,
purposes of the substantial presence test. complete Parts I and II of Form 8843. If 2. Whether you have taken affirmative
you have a “Q” visa, complete Part I and steps to change your status from
1. Days you regularly commuted to nonimmigrant to lawful permanent
work in the United States from a only lines 6 through 8 of Part II. On line
6, enter the name, address, and resident.
residence in Canada or Mexico.
telephone number of the director of the If you qualify to exclude days of
2. Days you were in the United States cultural exchange program in which you presence as a student, complete Parts I
for less than 24 hours when you were participated. and III of Form 8843. If you have a “Q”
traveling between two places outside the visa, complete Part I and only lines 10
United States. Exception. If you were exempt as a through 14 of Part III. On line 10, enter
3. Days you were temporarily in the teacher, trainee, or student for any part of the name, address, and telephone
United States as a regular crew member of 2 of the 6 prior calendar years, you can number of the director of the cultural
a foreign vessel engaged in transportation exclude days of presence in 2009 as a exchange program in which you
between the United States and a foreign teacher or trainee only if all four of the participated.
country or a possession of the United following apply.
States unless you otherwise engaged in 1. You were exempt as a teacher,
trade or business on such a day. trainee, or student for any part of 3 (or
fewer) of the 6 prior calendar years.
4. Days you were unable to leave the
United States because of a medical 2. A foreign employer paid all your
condition or medical problem that arose compensation during 2009.
while you were in the United States.
Form 8843 (2009) Page 4

Part IV—Professional Penalty for Not Filing Specific Instructions

Athletes Form 8843 Part I—General Information
A professional athlete is an individual If you do not file Form 8843 on time, you If you are attaching Form 8843 to Form
who is temporarily present in the may not exclude the days you were 1040NR or Form 1040NR-EZ, you are
United States to compete in a charitable present in the United States as a not required to complete lines 1 through
sports event. For details on charitable professional athlete or because of a 3b of Form 8843 if you provide the
sports events, see Pub. 519. medical condition or medical problem requested information on the
that arose while you were in the United corresponding lines of Form 1040NR or
If you qualify to exclude days of
States. Failure to exclude days of 1040NR-EZ. In this case, enter
presence as a professional athlete,
presence in the United States could "Information provided on Form 1040NR"
complete Parts I and IV of Form 8843.
result in your being considered a U.S. or "Information provided on Form
Part V—Individuals With a resident under the substantial presence 1040NR-EZ" on lines 1 through 3b of
test. Form 8843.
Medical Condition or
You will not be penalized if you can Line 1b. Enter your current
Medical Problem show by clear and convincing evidence nonimmigrant status, such as that
For purposes of the substantial presence that you took reasonable actions to shown on your current Immigration Form
test, do not count the days you intended become aware of the filing requirements I-94, Arrival-Departure Record. If your
to leave the United States but could not and significant steps to comply with status has changed while in the United
do so because of a medical condition or those requirements. States, enter the date of change.
medical problem that arose while you
were in the United States. Whether you
intended to leave the United States on a
particular day is determined based on all Paperwork Reduction Act Notice. We ask for the information on this form to carry
the facts and circumstances. For more out the Internal Revenue laws of the United States. Section 7701(b) and its
details, see Pub. 519. regulations require that you give us the information. We need it to determine if you
can exclude days of presence in the United States for purposes of the substantial
If you qualify to exclude days of presence test.
presence because of a medical
condition or medical problem, complete You are not required to provide the information requested on a form that is subject
Part I and lines 17a through 17c. Have to the Paperwork Reduction Act unless the form displays a valid OMB control
your physician or other medical official number. Books or records relating to a form or its instructions must be retained as
complete line 18. long as their contents may become material in the administration of any Internal
Revenue law. Generally, tax returns and return information are confidential, as
When and Where To File required by section 6103.
If you are filing a 2009 Form 1040NR or The average time and expenses required to complete and file this form will vary
Form 1040NR-EZ, attach Form 8843 to depending on individual circumstances. For the estimated averages, see the
it. Mail your tax return by the due date instructions for your income tax return.
(including extensions) to the address
shown in your tax return instructions. If you have suggestions for making this form simpler, we would be happy to hear
from you. See the instructions for your income tax return.
If you do not have to file a 2009 tax
return, mail Form 8843 to the
Department of the Treasury, Internal
Revenue Service Center, Austin, TX
73301-0215 by the due date (including
extensions) for filing Form 1040NR or
Form 1040NR-EZ.